The majority of adults with mild osteogenesis imperfecta report significant functional impairment due to musculoskeletal concerns. Knee osteoarthritis is common in these patients. Although total knee arthroplasty has become a highly efficient surgical technique for osteoarthritis, this procedure remains uncommon in patients with osteogenesis imperfecta. This current case report describes the important clinical aspects of osteogenesis imperfecta that must be considered during the planning and performance of a total knee replacement. A 62-year-old female patient with a history of osteogenesis imperfecta suffered from severe osteoarthritis of the knee with valgus deformity. Two years after posterior stabilized total knee arthroplasty, her Hospital for Special Surgery knee score had improved from preoperative 53 points to 85 points at the final follow-up. The current case report describes the crucial technical aspects of a successful total knee replacement in this uncommon scenario. Underlying deformities and concomitant pathologies constitute specific surgical challenges. Special care should be taken to protect the patient from potential complications.
- MeSH
- artróza kolenních kloubů * komplikace diagnostické zobrazování chirurgie MeSH
- dospělí MeSH
- kolenní kloub diagnostické zobrazování chirurgie MeSH
- koleno MeSH
- lidé středního věku MeSH
- lidé MeSH
- osteogenesis imperfecta * komplikace chirurgie MeSH
- totální endoprotéza kolene * metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
Introduction: The present study compares the outcome of the long cemented stem and the revision uncemented stem used in periprosthetic femoral fractures. We propose that the revision with a long stem cemented prosthesis does not compromise fracture healing. Patients and Methods: A consecutive series of 37 patients, operated between 2010 and 2017, were enrolled in a retrospective analysis. A long cemented stem was implanted in 21 patients (study group; age at operation: 63 to 89 years). A distally tapered fluted uncemented stem was used in 16 patients (control group; age at operation: 35 to 77 years). The clinical outcome was evaluated with Merle d'Aubigné and Postel scoring system. Standard radiographs were taken before surgery, at 3, 6, and 12 months postoperatively, and last follow-up. Any and all complications during the follow-up period were recorded. Results: Although a significant difference (P = 0.006) was observed in the post-operative Merle d´Aubigné score over the 12-month follow-up period, no significant difference (P = 0.066) was found in the post-operative pain score between the study and control groups. Periodic radiographic assessments showed the disappearance of radiolucent lines and the diaphyseal part of the fracture was healed in all 34 followed-up cases during the first annual follow-up. Early surgical complications were seen in both groups, the medical complications were observed only in the study group. Conclusion: Based on our results, periprosthetic fractures of the femur after a total hip arthroplasty were associated with significant morbidity and increased mortality in elderly patients. Revision with a long-stem cemented prosthesis provided early pain-free weight-bearing without compromising the healing of femoral fractures in elderly patients with osteoporotic bone, altered mobility, poor balance, and reduced cognitive capacity.
- MeSH
- femur chirurgie MeSH
- fraktury femuru * chirurgie MeSH
- kyčelní protézy * MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhrada kyčelního kloubu * škodlivé účinky MeSH
- periprotetické fraktury * chirurgie MeSH
- reoperace MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
Background: Spondyloepiphyseal dysplasia is the clinical term applied to a group of rare genetic disorders with primary involvement of the vertebrae and epiphyses, predisposing the afflicted individuals toward the premature development of osteoarthritis. There are few reports concerning joint replacement therapy in these patients, particularly describing the role of total hip arthroplasty. In this report, we describe the anatomical and technical aspects of spondyloepiphyseal dysplasia that must be considered during surgical planning and performance of total knee arthroplasty. Case Presentation: A 49-year old woman with a history of spondyloepiphyseal dysplasia suffered from severe osteoarthritis of the knee and irreducible congenital dislocation of the patella. After careful preoperative evaluations and planning, the knee joint deformity was solved by knee joint replacement with realignment of the extensor mechanism using quadricepsplasty. After 2 years of surgery, the patient showed no pain and was able to walk with the help of elbow crutches. The Hospital for Special Surgery knee score increased from preoperative 51 points to 85 points during the final follow-up. The postoperative range of motion increased to final flexion of 0-115°. Conclusion: The advances made so far in the medical care for patients with skeletal dysplasia have improved their overall survival during adulthood. The case report described herein demonstrates the numerous challenges and technical aspects of a successful total knee arthroplasty in cases of spondyloepiphyseal dysplasia, highlighting the need to consider skeletal and soft tissue abnormalities of skeletal dysplasia during the planning and performance of joint replacement surgery.
- Publikační typ
- kazuistiky MeSH
Úvod: Cílem práce je zhodnocení našich zkušeností s kortikálními aloštěpy použitými jako biologické dlahy při léčení zlomenin stehenní kosti. Materiál a metoda: V období od listopadu 2011 do února 2013 jsme na našem pracovišti léčili 6 žen s frakturou stehenní kosti, při jejichž operační léčbě byly použity kortikální alogenní onlay štěpy. Masivní aloštěp femorální byl použit 5x a fibulární 1x. Pacienty jsme sledovali klinicky a rentgenologicky v odstupu 6 týdnů od operace, po 3, 6, 9 a 12 měsících a dále po roce. Nejkratší doba sledování byla 9 měsíců s průměrem 18 měsíců, všech 6 pacientek se dostavilo řádně ke kontrolám. Výsledky: Ke zhojení zlomeniny femuru došlo u 5 pacientek s příznivým funkčním výsledkem v odstupu 9 až 24 měsíců po provedené osteosyntéze. U jedné pacientky jsme zaznamenali komplikaci. Jednalo se o stresovou frakturu fibulárního aloštěpu s refrakturou femuru, která vznikla za 8 měsíců po operaci a která si vyžádala další operační intervenci. Diskuze: Použití solidních alogenních onlay štěpů jako biologické dlahy, buď samostatné, nebo jako doplňující fixace v kombinaci s dlahovou osteosyntézou při léčení zlomenin kosti stehenní, představuje náročnou operační techniku, při níž je nezbytné respektovat biomechanické a biologické principy. Tato technika je cenná zejména při léčbě periprotetických zlomenin s nároky na obnovení kostní hmoty v důsledku těžké osteopenie nebo přítomných kostních defektů vzniklých na podkladě uvolnění, extrakce či malpozice dříku.
Introduction: The aim of this work is to evaluate our experience with cortical allografts used as a biological splint in the treatment of fractures of the femur. Material and Methods: Between November 2011 and February 2013 we treated 6 women with a fracture of the femur at our department. Allogenic cortical onlay grafts were used as a part of surgical treatment. Massive femoral allograft was used 5 times while a fibular one was used once. Patients were followed clinically and radiographically at intervals of 6 weeks after surgery, after 3, 6, 9 and 12 months and beyond. The shortest follow-up was 9 months with an average of 18 months, all 6 patients are attended the follow up examinations properly. Results: The femoral fractures got fully healed in 5 patients, with a favourable functional outcome at intervals of 9-24 months after internal fixation. In one patient we observed complications. It was a stress fracture of the fibular allograft with a re-fracture of the femur, which occurred at 8 months after surgery and which required further surgical intervention. Discussion: The use of solid allogenic onlay grafts as biological splints, either alone or as a complementary fixation in combination with plate osteosynthesis in the treatment of fractures of the femur is a demanding surgical technique in which it is necessary to respect the biomechanical and biological principles. This technique is especially valuable in the treatment of periprosthetic fractures with demands for restoration of bone mass due to severe osteopenia or bone defects present on the basis of the release or extraction of stem malposition.
- MeSH
- dospělí MeSH
- fraktury femuru * etiologie chirurgie MeSH
- homologní transplantace * metody MeSH
- kostní destičky využití MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhrada kyčelního kloubu MeSH
- periprotetické fraktury chirurgie MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- vnitřní fixace fraktury metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- hodnotící studie MeSH
- práce podpořená grantem MeSH
PURPOSE OF THE STUDY: Leukocyte esterase is an enzyme in neutrophils from which it is released into exudate; its detection by colorimetric test strips indicates the presence of neutrophils. This is a rapid method to find whether exudate is of infectious or non-infectious aetiology. The aim of the study was to determine the sensitivity and specificity of leukocyte esterase testing with use of AUTION Sticks (Arkray) for examination of exudates obtained in inflammatory diseases of the skeletal system. MATERIAL AND METHODS: Exudates associated with skeletal system diseases were collected from 45 patients in the period from July 1st to December 31 st , 2012. Aspirates obtained under sterile conditions were examined for leukocyte esterase; cytological and microbiological examinations were also carried out. For the detection of leukocyte esterase, a drop of aspirate was placed on the reagent zone of a test strip and the resulting colour reaction was read after 90 minutes. Changes in colour were compared with a reference strip provided by the manufacturer. The results were assessed on a five-shade scale as follows: 0, no colour change; 1 to 4, gradual change from light pink to deep purple. The results were compared with those of cytological and microbiological examinations. Shade 4 on the strip corresponded to a positive cytological finding of bacterial infection, and shades 3 and 4 correlated with a positive microbial finding. The sensitivity and specificity of leukocyte esterase testing were statistically evaluated for both comparisons. RESULTS: Based on the results of cytological and microbiological examinations, an infectious aetiology of exudate was diagnosed in 21 (44.4%) and non-infectious aetiology in 24 (63.6%) patients. With leukocyte esterase reagent strips when shade 4 was taken as a positive result, the sensitivity and specificity of examination was assessed as 0.6190 and 0.9583, respectively. When taking both shade 3 and shade 4 for a positive result, sensitivity and specificity were 0.8571 and 0.8750, respectively. Shades 0 and 1 corresponded to the number of leukocytes in exudate that was no higher than 2 x 10⁹/ml. DISCUSSION: The detection of leukocyte esterase is a quick and easy examination. It is useful for readily excluding or confirming an infectious aetiology of exudate and can, to some extent, substitute a cytological examination. It can also help to make a quick decision whether one- or two-stage joint reimplantation should be performed and thus eliminate the need of intra-operative histological examination of frozen tissue samples. A drawback of the method was that exudate samples contaminated with blood interfered with an assessment of colour shades. However, this can be avoided by centrifugation of the sample and use of a supernatant free from erythrocytes. CONCLUSIONS: Diagnosing infectious aetiology of joint exudate or exudate from an abscess using leukocyte esterase reagent strips appears, according to our results, to be a promising, semi-quantitative method with high specificity and sensitivity which is rapid, simple and affordable. It can be useful particularly in out-patient institutions for a quick diagnosis of arthritis; intraoperatively, it can serve as an additional method to other exudate examinations.
- MeSH
- absces diagnóza mikrobiologie MeSH
- artritida diagnóza mikrobiologie MeSH
- bakteriální infekce diagnóza MeSH
- cytodiagnostika MeSH
- exsudáty a transsudáty enzymologie MeSH
- karboxylesterhydrolasy analýza MeSH
- lidé MeSH
- nemoci kostí diagnóza mikrobiologie MeSH
- neutrofily enzymologie MeSH
- reagenční papírky * MeSH
- senzitivita a specificita MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- srovnávací studie MeSH
Periprosthetic fractures are the third most common reason for revision total hip arthroplasty. Surgical treatment of periprosthetic fractures belongs to the most difficult procedures due to the extensive surgery, elderly polymorbid patients and the high frequency of other complications. The aim of this study was to evaluate the results of operatively treated periprosthetic femoral fractures after total hip arthroplasty. We evaluated 47 periprosthetic fractures in 40 patients (18 men and 22 women) operated on between January 2004 and December 2010. The mean follow-up period was 27 months (within a range of 12-45 months). For the clinical evaluation, we used modified Merle d'Aubigné scoring system. In group of Vancouver A fractures, 3 patients were treated with a mean score of 15.7 points (good result). We recorded a mean score of 14.2 points (fair result) in 6 patients with Vancouver B1 fractures, 12.4 points (fair result) in 24 patients with Vancouver B2 fractures and 12.7 points (fair result) in 7 patients with Vancouver B3 fractures. In group of Vancouver C fractures, we found a mean score of 16.2 points (good result) in 7 patients. Therapeutic algorithm based on the Vancouver classification system is, in our opinion, satisfactory. Accurate differentiation of B1 and B2 type of fractures is essential. Preoperative radiographic images may not be reliable. If in doubt, checking the stability of the prosthesis fixation during surgery should be performed.
- MeSH
- fraktury femuru chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhrada kyčelního kloubu * MeSH
- periprotetické fraktury chirurgie MeSH
- reoperace MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- výběr pacientů MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
